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How effective is liposuction for gynaecomastia in men?

How effective is liposuction for gynaecomastia in men?
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Gynaecomastia means enlarged male breast tissue, affectionately known as ‘man boobs’. There are two types of gynaecomastia, one being glandular in nature with the other being fatty. Purely fatty male breast tissue is known as pseudo-gynaecomastia, and the best treatment is liposuction.

Men with gynaecomastia or pseudo-gynaecomastia may feel a rubbery or firm mass, running in concentric circles outwards from the nipple. Alternatively, they could have excessive fatty deposits in the breasts. Estimates suggest that about 40 per cent of the male population is affected by enlarged breast tissue.

Gyneco – woman, female
Mastia (from mastos) – breast

Why do some men grow breasts?

The reason men may grow breasts is both simple and complex, but the crux of it is that when we’re nothing but a bunch of quickly multiplying cells in the womb, we all start biologically female. That is, we all develop female until the message is received for some of us to differentiate and switch.

The instruction to differentiate to a boy or girl is in the sperm.  Thus sperm dictates the sex of a baby, not the egg. This bit of biology is not by chance. A sperm is either male or female. The differentiation process from female to male occurs during foetal development, but we all start with the same gear, which is why men have nipples and can grow breasts.

It might surprise you to discover that a biological man has as much physical capacity to breastfeed as a biological woman does. Men can also develop breast cancer.

A trans woman (a biological male who identifies as a female) undergoing physical transition who wishes to grow breasts can do so; under the influence of naturally-occurring or introduced oestrogen, a biological male can and will grow breasts.

These breasts don’t usually get as big as a biological female’s (without breast implants), but the ducting system works just fine. Trans women can, with the right concoction of hormones and medication, successfully breastfeed.

(Don’t believe it? Read it for yourself.)

So what does this have to do with a biological male who has started growing breasts against his will?

Gynaecomastia occurs due to the influence of oestrogen in a man’s body, which can be caused by a relative increase in oestrogen or a corresponding decrease in androgens, or both. What this means is that oestrogen has the opportunity to plug itself into more receptors than it might normally. As a result, breasts, milk ducts and all, start to develop, and fat accumulates.

Oestrogen, oestrogen-like substances (known as xenoestrogens), or the use of anabolic steroids can stimulate glandular and fat development in the breast tissue of men.

Understanding the differences between gynaecomastia and pseudo- gynaecomastia

Pseudo-gynaecomastia occurs most often when a man is carrying around extra weight; however, it’s not just being chubby that causes the breast tissue to develop, especially when it is more glandular in nature.

The more fat we have, the more oestrogen we have (all genders). The more oestrogen a man has, the more receptors are filled by the oestrogen, causing oestrogenic effects on the body.

The conversion of testosterone to oestrogen occurs inside fat cells. In the fat cell, an enzyme known as aromatase has just one job: to convert testosterone into oestrogen.

Aromatase is only present in fat cells; thus, the more fat, the more testosterone is converted to oestrogen.

The development of gynaecomastia – what it feels like and what’s happening

Gynaecomastia starts with the milk ducts becoming more numerous and elongating. Connective tissue density increases and the ducts become swollen and inflamed, causing tender breasts. This process usually occurs within the first six months of onset.

After about a year, the breast tissue becomes very fibrous, but the inflammation has disappeared, meaning there is no longer tenderness or pain.

There are four grades of severity ranging from a simple protrusion of the areolar to full feminine breasts.

It can be useful to treat gynaecomastia in the first six months of it appearing and before the tissue becomes fibrotic. Fibrotic tissue can be somewhat harder to manage, but it can be treated at any stage.

Treatments for gynaecomastia and pseudo-gynaecomastia

  • When breast development is minor and recent, diet and exercise modifications may be an appropriate and effective way to reduce the oestrogenic load naturally
  • Liposuction (which we offer at ENRICH Clinic) for fatty breast tissue
  • Surgical tissue removal for glandular/fibrotic breast tissue

How do I tell if I have more glandular or fatty breast tissue?

You can generally tell if breast tissue is dense in glandular tissue as it will feel firm, versus fatty tissue which tends to be wobbly and softer.

It’s important to have a consultation with Dr Rich to determine glandular-fat ratios and see if liposuction will be the best option for you.  Liposuction doesn’t remove glandular tissue – just fat – so you may need to consider other options.

The emotional impacts of male breast tissue development

Men frequently feel anxious and uncomfortable with excess breast tissue development. Some men are afraid of developing breast cancer, which isn’t as rare as you might think. Male breast cancer develops less frequently than in biological females but is still a legitimate health concern of men.

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